Laserfiche WebLink
l ' <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Jack Tone Rd CITY/ZIP Stockton,Ca 95215 D <br /> CROSS STREET APN 181-170-09 PARCEL SIZE T l• LAND USE APPLICATION III <br /> w <br /> OWNER NAME Thompson Ranch PHONE •`r' <br /> x2 C '`` <br /> OWNER ADDRESS ��d/ / J `� Mi� CITY/STATE/ZIP <br /> CONTRACTOR Dan's Water Well&Pump Service,Inc PHONE 888326.9355 <br /> CONTRACTOR ADDRESS 3494 Camino Tassajara#203 CITY/STATE/ZIP Danville.Ca 94506 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 892546 EXPIRATION DATE 03/17 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> INTENDED USE Domestic/Private Xlrrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner water System Name Come eme or one um er <br /> TYPE OF WORK X New Well Replacement Well Well Alteration/Modification Other �' E­D <br /> #of borings of orings r IR <br /> Ar <br /> Monitoring Well(s) #of wells Soil Bonng(s) o n ��� <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Con echo Pte it <br /> New Pum Pum Replacement Pum Repair Raise Well Cas' �'f +� i without WELL CONSTRUCTION lair r r r' may have exp! ed C'I ithout <br /> Drilling Method X Mud Rotary Air Rotary Auger Cable Tool Push Point Other <br /> Proposed Well Depth 250 ft Excavation 2D in diameter Open Bottom Gravel C I r 1 I1 15pec:-d <br /> An <br /> Conductor Casing in diameter / Conductor Casing Depth ft 9fnle��,rif�b�!?r owns l N� 1�IVlS1on <br /> Well Casing Diameter 16 in Thickness/Gauge/ASTM Sched .250 X Steel Plastic Stbv s r u • •,, 1 •7 <br /> Grout Seal Depth It Neat Cement(94/b bag/5-10 gal water) Sand Cement 10.3 sk sand slurry sack m/x/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method X Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller X Pump Contractor Other <br /> X Concrete Pedestal Dimensions:Width It Length ft Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set it Standing Water Level ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 2'4 HOUR�I,fNMEICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> /'(,� <br /> SIGNED ;L(-ti' TITLE President DATE <br /> MIT <br /> F-rM't ►m ' EIVE® <br /> e':0�tlCl(1_ <br /> by 1-�frrAPR� ' ' 20 2015 <br /> SW JOA 11.114 <br /> EK <br /> HEu-T1't H ENTAL HEALTH <br /> /SERVICES <br /> I--T—T— 2-1 1 <br /> DEPARTMENT gUSE ONLY <br /> Application Accepted By _ Date T vt Area,') Employee IC 4S4o IVa 1'd� <br /> Grout Inspection By Date SPECIAL Well Permit I <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B Cash Remitted Service Request# <br /> (► l �� isc� ; 1"g., SJ?DDOD$ <br /> EHD 43-06 <br /> 4/30/12 WELL/PUMP PERMIT <br />